Pathophysiology Pathophysiology. Chapter 1. Introduction to Pathophysiology 1.What is...

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Pathophysiology Pathophysiology

Transcript of Pathophysiology Pathophysiology. Chapter 1. Introduction to Pathophysiology 1.What is...

Page 1: Pathophysiology Pathophysiology. Chapter 1. Introduction to Pathophysiology 1.What is Pathophysiology 1.What is Pathophysiology 2.Why do we need Pathophysiology?

PathophysiologyPathophysiology

Page 2: Pathophysiology Pathophysiology. Chapter 1. Introduction to Pathophysiology 1.What is Pathophysiology 1.What is Pathophysiology 2.Why do we need Pathophysiology?

Chapter 1.Chapter 1. Introduction to Introduction to PathophysiologyPathophysiology

1.1.What is PathophysiologyWhat is Pathophysiology 2.2.Why do we need Pathophysiology?Why do we need Pathophysiology? 3.3.What will we learn in the What will we learn in the

classroom? classroom? 4.4.The position of Pathophysiology inThe position of Pathophysiology in medical educationmedical education 5.5.The research methods The research methods 6.6.Learn the ability of clinical thinking Learn the ability of clinical thinking

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1.1.What is What is PathophysiologyPathophysiology

Patho—physiology ? Patho—physiology ?

(1) Etiology(1) Etiology 病因学病因学 (2)(2)PathogenesisPathogenesis 发病学发病学 Functional change(dysfunction)Functional change(dysfunction) Metabolic changeMetabolic change Reasons of symptoms and signsReasons of symptoms and signs (3)Basic principle of management(3)Basic principle of management

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2.2.Why do we need Why do we need Pathophysiology?Pathophysiology?

Two casesTwo cases (1) A case of infantile diarrhea(1) A case of infantile diarrhea (( 2) 2) A case of breathing with difficultyA case of breathing with difficulty

学习园地的 学习园地的 humour humour   

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3.3.What will we learn in the What will we learn in the course of Pathophysiologycourse of Pathophysiology

(1)A general outline of disease(Chapter 2)(1)A general outline of disease(Chapter 2) ((2)Cellular and molecular pathophysiology2)Cellular and molecular pathophysiology (Chapter 3-5) (Chapter 3-5) (3)Basic pathological process (Chapter 6-(3)Basic pathological process (Chapter 6-

14)14) (4)Systemic pathological process (15-20)(4)Systemic pathological process (15-20)

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4.4.The position of The position of Pathophysiology in medical Pathophysiology in medical education?education? As a bridge-scienceAs a bridge-science

(1) Explain the functional (1) Explain the functional (effect of decreased (effect of decreased

myocardial contraction on the body) myocardial contraction on the body) and metabolic and metabolic changes changes (increased ATP consumption)(increased ATP consumption) in diseases with in diseases with the knowledge of Physiology, Biochemistry ....the knowledge of Physiology, Biochemistry ....

(2)(2)Pathology (Pathological Anatomy) pays Pathology (Pathological Anatomy) pays attention to morphological changes in attention to morphological changes in diseases. with microscope. diseases. with microscope. (myocarditis)(myocarditis)

(3) Base of clinical courses(3) Base of clinical courses

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5.5.Research methodsResearch methods

(1)Duplicate the disease model in animals(1)Duplicate the disease model in animals

(( 特色特色 ))

(2)(2)Clinical surveyClinical survey

(3)(3)Epidemiological Study (Framinghan Epidemiological Study (Framinghan Study)Study)

(4) Cell culture, organ culture,(4) Cell culture, organ culture,

molecular biiology..….molecular biiology..….

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6. Learn the ability of clinical 6. Learn the ability of clinical thinking (finding, analyzing and thinking (finding, analyzing and resolving abnormal manifestations)resolving abnormal manifestations)

Case discussion Case discussion Ask questionAsk question Climb a tree (a story)Climb a tree (a story)

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Chapter 2. Chapter 2. Etiology and Pathogenesis Etiology and Pathogenesis

1.1.Some conceptsSome concepts

2.2.EtiologyEtiology

3.3.Pathogenesis Pathogenesis

4.4.Ending of disease Ending of disease

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1.1.Some conceptsSome concepts

(1) Health (1) Health (2)(2)Sub-healthSub-health (3) (3) DiseaseDisease (4)Pathological process(4)Pathological process (5)Senescence (5)Senescence 衰老衰老

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(1)Health≠no disease(1)Health≠no disease

According to the definition According to the definition forwarded by WHO, the health means forwarded by WHO, the health means the state of complete well-being in the state of complete well-being in body, mind and society.body, mind and society.

utopiautopia

The health at least means no The health at least means no illness and no mental problems.illness and no mental problems.

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(2) Sub-health(2) Sub-healthChronic fatigue syndromeChronic fatigue syndrome

Intermediate state between Intermediate state between disease and health.disease and health.

The sub-healthy state, referred to The sub-healthy state, referred to a functional change without organic a functional change without organic pathological process, and also called pathological process, and also called a a third state or a gray state, third state or a gray state, without without positive finding in physical and positive finding in physical and laboratory investigation.laboratory investigation.

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(3)(3)DiseaseDisease Disease is not dis(Disease is not dis(no) no) - - easeease.. The definition of disease:The definition of disease: ① ① Disease is an abnormal life process Disease is an abnormal life process

caused by certain reasons and conditions. caused by certain reasons and conditions. There is no disease without cause. There is no disease without cause.

② ②There must be some functional , There must be some functional , metabolic and structural changes in the metabolic and structural changes in the body with disease. body with disease.

③ ③The patients should have some The patients should have some symptoms and signs. symptoms and signs.

④ ④ Conforming the laws of the happening, Conforming the laws of the happening, developmentand ending of the diseases.developmentand ending of the diseases.

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SymptomSymptom is the subjective complaint is the subjective complaint which is noted by patients, such as pain, which is noted by patients, such as pain, (headache), nausea, dizziness, and itching. (headache), nausea, dizziness, and itching.

SignSign is the objective manifestation that is is the objective manifestation that is

noted by doctors, nurses or other observers noted by doctors, nurses or other observers such as high temperature (measured by such as high temperature (measured by thermometer), cyanosis (purple skin), thermometer), cyanosis (purple skin), jaundice(yellow skin and cornea).jaundice(yellow skin and cornea).

Patients might tell lies.Patients might tell lies.

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FatigueFatigue Loss of appetiteLoss of appetite

Someone may make a show to deceive.

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SyndromeSyndrome

– Syndrome is a group of symptoms Syndrome is a group of symptoms and signs that occur together, which have and signs that occur together, which have close internal relations.In many cases, close internal relations.In many cases, syndrome is a new disease in which the syndrome is a new disease in which the exact reason is unknown at the beginning, exact reason is unknown at the beginning, for example: for example:

SARS SARS (severe acute respiratory (severe acute respiratory syndrome).syndrome).

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The SARS consists of The SARS consists of (1)low artery oxygen pressure (PaO(1)low artery oxygen pressure (PaO22),), (2)dyspnea (shortness of respiration),(2)dyspnea (shortness of respiration), (3)symptoms and signs of hypoxia,(3)symptoms and signs of hypoxia,

(4) cyanosis(4) cyanosis..     The internal relation may be the The internal relation may be the

special kind of virus infection from special kind of virus infection from animals, but at first ,it is not clear.animals, but at first ,it is not clear.

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WHO report:WHO report:

Health 5%Health 5% Sub-health 75%Sub-health 75% Disease 20%Disease 20% Dynamic transforming Dynamic transforming

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(4) (4) Pathological ProcessPathological Process

The pathological process indicates The pathological process indicates a set a set ofof functional, metabolic and structural functional, metabolic and structural disturbances , which occur in the diseases. disturbances , which occur in the diseases.

These functional, metabolic and These functional, metabolic and structural changes have close internal structural changes have close internal relations. relations.

There is a set of functional (increased There is a set of functional (increased heart rate), metabolic (cyanosis) and heart rate), metabolic (cyanosis) and structural changes (cellular edema) in structural changes (cellular edema) in hypoxia. Hypoxia is a pathological process.hypoxia. Hypoxia is a pathological process.

Hypoxia is not a disease.Hypoxia is not a disease.

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Hypoxia can occur in pneumonia, Hypoxia can occur in pneumonia, bronchitis, heart failure, anemia and some bronchitis, heart failure, anemia and some other diseases. other diseases.

Pneumonia is a disease with hypoxia.Pneumonia is a disease with hypoxia. Bronchitis is a disease with hypoxia. Bronchitis is a disease with hypoxia. Almost all the names of chapters and Almost all the names of chapters and

sections (hypoxia, fever, acidosis, alkalosis, sections (hypoxia, fever, acidosis, alkalosis, etc.) are pathological processes. etc.) are pathological processes.

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(5) Senescence (5) Senescence 衰老衰老 AgingAging 老化老化

是机体的正常生理功能随着年龄的是机体的正常生理功能随着年龄的增长而缓慢减退的一个不可逆的过程增长而缓慢减退的一个不可逆的过程 ..

是机体在退化时期功能下降和生理紊乱是机体在退化时期功能下降和生理紊乱的综合表现的综合表现 ..

原因原因 :: 自由基水平自由基水平 染色体端粒长度染色体端粒长度 衰老相关基因衰老相关基因

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2.2.Etiology of DiseaseEtiology of Disease

Etiology is the science to Etiology is the science to study the causes of the diseases. study the causes of the diseases.

(1) Etiological factors (causes of (1) Etiological factors (causes of

diseases)diseases)

(2) Conditions of disease development(2) Conditions of disease development

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(1) (1) Etiological factorsEtiological factors

Etiological factor is the cause Etiological factor is the cause which which determines the characters or determines the characters or naturenature of the disease. of the disease. There are two kinds of etiological There are two kinds of etiological factors:factors: 1)extrinsic etiological factors,1)extrinsic etiological factors, 2)intrinsic etiological factors.2)intrinsic etiological factors.

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1)Extrinsic etiological 1)Extrinsic etiological factors:factors:

Extrinsic etiological factors come from Extrinsic etiological factors come from outside of the body, such as:outside of the body, such as: (1)Infection of hepatitis virus leads to the(1)Infection of hepatitis virus leads to thehepatitis. The hepatitis virus determines the hepatitis. The hepatitis virus determines the nature of disease (hepatitis). The hepatitis virus nature of disease (hepatitis). The hepatitis virus never leads to pneumonia directly . never leads to pneumonia directly . The hepatitis virus is the extrinsic The hepatitis virus is the extrinsic etiological factor of hepatitis.etiological factor of hepatitis. (2)Infection of pneumococcus leads to(2)Infection of pneumococcus leads to pneumonia. pneumonia.

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2)Intrinsic etiological 2)Intrinsic etiological factorsfactors

Intrinsic etiological Intrinsic etiological factors come from the inside factors come from the inside of the body, for example: of the body, for example: Mutation of LDLR gene Mutation of LDLR gene causes familial causes familial hypercholesterolemia. hypercholesterolemia.

Gene mutations Gene mutations determine the nature of determine the nature of diseases, gene is within the diseases, gene is within the body, so gene mutation is body, so gene mutation is the intrinsic etiological the intrinsic etiological factor.factor.

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Atherosclerosis of Atherosclerosis of coronary artery is coronary artery is the cause the cause (etiological factor) (etiological factor) of myocardial of myocardial infarction.infarction.

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(2) Conditions of (2) Conditions of disease developmentdisease development 有病因作用的前提下有病因作用的前提下 ,, 影响发生发影响发生发

展的因素展的因素 , , 条件本身不直接引起疾病条件本身不直接引起疾病 ..

1) 1) Precipitating factors(Precipitating factors( 诱因诱因 )) 2) 2) Predisposing factor(Predisposing factor( 易感性) 易感性) 3) 3) Risk factorsRisk factors

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1)1)Precipitating factors(Precipitating factors( 诱因诱因 )) A precipitating factor is A precipitating factor is

the condition which the condition which promotes the development promotes the development of disease in short time of disease in short time through through enhancing the effect enhancing the effect of etiological factors.of etiological factors.

The sudden increase of vasoconstriction is the precipitating factor to myocardial infarction.

Lean meat for patients with cirrhosis???

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2) 2) Predisposing factorPredisposing factor(( 易感性)易感性)

Predisposing factors are the Predisposing factors are the conditions which conditions which influence the influence the susceptibility or resistance of the bodysusceptibility or resistance of the body to certain disease.to certain disease.

The etiological factor of common The etiological factor of common cold is influenza virus.cold is influenza virus.

The cold weather reduces the The cold weather reduces the person’s resistance to influenza virus. person’s resistance to influenza virus.

The cold weather is the The cold weather is the predisposing factor of common cold. predisposing factor of common cold.

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Malnutrition:Malnutrition: for tuberculosis, ?for tuberculosis, ? for edema ? for edema ?

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3) 3) Risk factorsRisk factors prospective studyprospective study

The Framingham Heart Study (FHS) The Framingham Heart Study (FHS) was started in 1948 as a prospective was started in 1948 as a prospective investigation of cardiovascular disease investigation of cardiovascular disease in a cohort of adult men and women. in a cohort of adult men and women. Continuous surveillance of this sample Continuous surveillance of this sample of 5209 subjects (1800 families) has of 5209 subjects (1800 families) has been maintained through biennial been maintained through biennial physical examinations. physical examinations.

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In 1971 examinations were begun In 1971 examinations were begun on the children of the FHS cohort(5124 on the children of the FHS cohort(5124 offspring and their spouses). This study, offspring and their spouses). This study, called the Framingham Offspring Study called the Framingham Offspring Study (FOS), was undertaken to expand upon (FOS), was undertaken to expand upon knowledge of cardiovascular disease, knowledge of cardiovascular disease, particularly in the area of familial particularly in the area of familial clustering of the disease and its risk clustering of the disease and its risk factors.factors.

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Till 1960s, they found that Till 1960s, they found that persons with fat, smoking, persons with fat, smoking, hypoactivate, hypoactivate, hypercholesterolemia, diabetes, hypercholesterolemia, diabetes, stress are susceptible to CHD.stress are susceptible to CHD.

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3. Pathogenesis 3. Pathogenesis 发病学发病学

(( 11 ) ) Fundamental mechanisms for Fundamental mechanisms for diseasesdiseases

(( 22 )) General rules for the General rules for the development and ending of the development and ending of the diseasesdiseases

((3) Stages of disease3) Stages of disease

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(( 11 )) Fundamental Fundamental mechanisms for mechanisms for diseasesdiseases 1) Neural mechanism1) Neural mechanism 2) Humoral mechanism2) Humoral mechanism 3) Cellular mechanism3) Cellular mechanism 4) Molecular mechanism4) Molecular mechanism

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no thirstno thirst

increase of ECF osmolality (1~2%)

hypovolemia elevated angiotensin II

dryness ofmouth

osmoreceptor (anterior hypothalamus

)

volume receptorin venae cavae and atrium

thirst center (anterior hypothalamus)

sense of thirst and drink of water

decrease of ECF

osmolality increase of ECF volume

decrease of angiotensin concentration II

disappear of dryness

1)Neural 1)Neural mechanismmechanism

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renal blood flow

[Na+] in macula densa

excitement of sympathetic nerve

renin release from the juxtaglomerular cells

increase of angiotensin II releases

[K+], [Na+] blood flow in plasma

aldosterone secretion from adrenal cortex

Na+ reaborption in renal tubules

K+ and H+ excretion from kidneys

2) Humoral 2) Humoral mechanismmechanism

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Neurohormoral Neurohormoral regulationregulation (systemic level)(systemic level) The data showed the bus The data showed the bus

drivers in London were drivers in London were susceptible to hypertension.susceptible to hypertension.

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3) Cellular mechanism3) Cellular mechanism

In hypoxia

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Familial lipoprotein lipase(LPL) deficiency is caused by LPL gene mutation. Disease proteomics ( 蛋白质组学 )

4) Molecular mechanism

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(( 22 )) General rules for the General rules for the development and ending of the development and ending of the diseasesdiseases

11)) 自 稳 态 紊 乱自 稳 态 紊 乱 ((disturbance of disturbance of homeostasis)homeostasis)

22)) 因果转化(因果转化( causalitycausality )) 33)) 损伤和抗损伤反应损伤和抗损伤反应 ((conflict of conflict of

injury and anti-injury )injury and anti-injury ) 44)) 局 部 和 整 体 的 关 系局 部 和 整 体 的 关 系 ((relation relation

between parts and entirety)between parts and entirety)

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11)Disturbance of )Disturbance of homeostasishomeostasis 各器官机能代谢活动在不断变化的内外环各器官机能代谢活动在不断变化的内外环

境中保护动态平衡,表现为各种生理性指标控境中保护动态平衡,表现为各种生理性指标控制在一个狭隘的范围内波动为制在一个狭隘的范围内波动为 homeostasis.homeostasis.

如:如: TT :: 36±0.5℃;36±0.5℃;      pH=7.35~7.45,pH=7.35~7.45,      heart rate heart rate 60~100/60~100/minmin 。。 DisturbanceDisturbance :: Increased body fluid causes edema.Increased body fluid causes edema. No sweat may lead to fever.No sweat may lead to fever.

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18591859 年实验医学的鼻祖年实验医学的鼻祖 founder,founder,法国 法国 Claude BernardClaude Bernard 名言:“生命名言:“生命只所以能生存,是因为不管外界如何变只所以能生存,是因为不管外界如何变化,自身总有一个稳定的内环境。” 化,自身总有一个稳定的内环境。”

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22) ) 因果转化(因果转化( causalitycausality ))

The primary cause leads to injury The primary cause leads to injury (result), which as a cause leads to (result), which as a cause leads to another injury (result), then another injury (result), then interchange of causes and results interchange of causes and results continuously. That is the way for both continuously. That is the way for both exacerbation and improement of exacerbation and improement of diseases.diseases.

Sometime it is vicious circle, or Sometime it is vicious circle, or benign circle.benign circle.

To recognize the leading (key) link is To recognize the leading (key) link is very important.very important.

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trauma rupture of blood vessel

hypovolemia

decreased venous return

tissuehypoxia

acidosis

vasodilation

leading (key) link ????leading (key) link ????

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33) Conflict of injury and ) Conflict of injury and anti-injuryanti-injury

Manifestations can be divided into:Manifestations can be divided into: (( 11 )) changes of injurychanges of injury (( 22 )) changes of anti-injury.changes of anti-injury. 相互依存,贯穿始终相互依存,贯穿始终 .. 相互斗争,主要矛盾方面决定疾病发展方向相互斗争,主要矛盾方面决定疾病发展方向 .. 有阶段性,如有阶段性,如 :: 烧伤烧伤 , , 疼痛、失液、感染三阶段。疼痛、失液、感染三阶段。 腹泻,开始为抗损伤,严重时为损伤。腹泻,开始为抗损伤,严重时为损伤。

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44)) Relation between parts and Relation between parts and

entiretyentirety

Any local manifestation should be Any local manifestation should be regarded as a part of systemic regarded as a part of systemic disease. A focus of infection can cause disease. A focus of infection can cause the increased WBC in blood and fever.the increased WBC in blood and fever.

Patients with diabetes susceptible Patients with diabetes susceptible to local infection.to local infection.

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((3)Stages of disease3)Stages of disease

For most of the diseases the For most of the diseases the course of disease can be divided course of disease can be divided into four stagesinto four stages..

1) Latent period1) Latent period

2) Prodromal stage2) Prodromal stage

3) Period of manifest illness3) Period of manifest illness

4) Ending of disease4) Ending of disease

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1) Latent period1) Latent period

This stage indicates the time after This stage indicates the time after exposure to the injurious agent (such as a child exposure to the injurious agent (such as a child has exposed to the measles virus) and before has exposed to the measles virus) and before the first appearance of signs and symptoms. the first appearance of signs and symptoms.

The latent period lasts several hours to The latent period lasts several hours to several days in cholera. several days in cholera.

In AIDS the latent period is several months In AIDS the latent period is several months to several years.to several years.

There is no latent period in some diseases. There is no latent period in some diseases. Such as electric shock.Such as electric shock.

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2) Prodromal stage2) Prodromal stage

There are some nonspecific There are some nonspecific signs and symptoms during this signs and symptoms during this stage, such as :stage, such as :

38℃ of body temperature,38℃ of body temperature, mild coughmild cough mild headache. mild headache.

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3) Period of manifest 3) Period of manifest illnessillness

In this stage the patients In this stage the patients appear all the specific and obvious appear all the specific and obvious signs and symptoms, such as in signs and symptoms, such as in children with measles:children with measles:

high temperature, high temperature, severe cough and severe cough and skin rash.skin rash. Measles can be diagnosed by Measles can be diagnosed by

these signs and symptoms.these signs and symptoms.

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Etiological factor Sign and Etiological factor Sign and symptomsymptom

------------------------------------------------------------------------------------------------------------------------------------------------------ Latent period exposed noLatent period exposed no   ------------------------------------------------------------------------------------------------------------------------------------------------------ Prodromal stage nonspecificProdromal stage nonspecific   ------------------------------------------------------------------------------------------------------------------------------------------------------ Period of manifest specific Period of manifest specific illness obviousillness obvious ------------------------------------------------------------------------------------------------------------------------------------------------------

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4) Ending of disease4) Ending of disease

There are three kinds of There are three kinds of possibility in the ending of possibility in the ending of diseases:diseases:

(a)complete recovery;(a)complete recovery; (b)incomplete recovery;(b)incomplete recovery; (c)death.(c)death.

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(a) Complete recovery(a) Complete recovery

The alterations of the function, The alterations of the function, metabolism and structure of the body metabolism and structure of the body which appeared in disease are which appeared in disease are perfectly restored. All the signs and perfectly restored. All the signs and symptoms disappear entirely. symptoms disappear entirely.

Common cold may have the Common cold may have the outcome of complete recoveryoutcome of complete recovery. . (most (most cannot)cannot)

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(b)Incomplete (b)Incomplete recovery recovery

The The mainmain signs and symptoms signs and symptoms are disappeared after treatment, but are disappeared after treatment, but some pathological changes are still some pathological changes are still present in the body. present in the body.

A relatively normal life activity can be maintained by mainly compensatory response.

Many patients have this kind of outcome.

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Atherosclerotic Atherosclerotic lesions in coronary lesions in coronary artery reduce the artery reduce the blood supply to the blood supply to the heart of the patient heart of the patient with CHD , the patient with CHD , the patient will have chest pain.will have chest pain. Nitroglycerin can dilate the blood vessel (coronary

artery) and increase the blood supply, but the lesions cannot disappear.

The outcome of patients with CHD can only have incomplete recovery, and may have chest pain again some time later.

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4. 4. DeathDeath

(1) Traditional concept of death(1) Traditional concept of death

(2) Modern concept of death (brain (2) Modern concept of death (brain death)death)

(3) Difference between brain death (3) Difference between brain death and persistent vegetative stateand persistent vegetative state

  

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(1)(1)Traditional concept of Traditional concept of deathdeath

Death is a process consisting of Death is a process consisting of   ①  ①agonal stage;agonal stage; ② ②stage of clinical death;stage of clinical death; ③ ③stage of biological death. stage of biological death.

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① ① Agonal stageAgonal stage

Severe functional, metabolic and Severe functional, metabolic and structural disturbances: structural disturbances:

lower temperaturelower temperature weak heart beat weak heart beat weak respiration weak respiration retardatory (delayed) nerve reflex.retardatory (delayed) nerve reflex. Not all the death has the agonal Not all the death has the agonal

stage, death from electricity has no stage, death from electricity has no this stage. this stage.

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②② Stage of clinical Stage of clinical deathdeath

The standards of this stage are:The standards of this stage are: cessation of heart-beat ,cessation of heart-beat , cessation of respiration, cessation of respiration, disappear of nerve reflex.disappear of nerve reflex. If the patient gets effective treatment, If the patient gets effective treatment,

the heart-beat, respiration and nerve the heart-beat, respiration and nerve reflex can be restored. reflex can be restored.

The stage of clinical death lasts 5~6 The stage of clinical death lasts 5~6 minutes, that means the doctor has only 5-minutes, that means the doctor has only 5-6 minutes of time to save the life of 6 minutes of time to save the life of patients.patients.

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③③ StageStage of biological deathof biological death The death is irreversible 5~6 The death is irreversible 5~6 minutes later after the stop of heart minutes later after the stop of heart beat and respiration. (something beat and respiration. (something useful)useful)

agonal stage clinical death biological death

---------------------------------------------------------------------------

heart-beat weak no, reversible no

irreversible

respiration slow, shallow no, reversible no

irreversible

nerve reflex retardation no, reversible no

irreversible

time 2~3 days 5~6 minutes

------------------------------------------------------------------------

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New challengeNew challenge

(1)1983(1)1983 年年 44 月月 1010 日参考消息:日参考消息: 19831983年年 11 月月 2424 日美国一日美国一 2525 岁孕妇脑出血,第二岁孕妇脑出血,第二天宣布死亡。但用支持生命系统让她继续生天宣布死亡。但用支持生命系统让她继续生理活动,让胎儿继续活,至理活动,让胎儿继续活,至 33 月月 2929 日剖腹产日剖腹产取出取出 13601360 克婴儿,然后停机器,母亲便死了。克婴儿,然后停机器,母亲便死了。

(2)1984(2)1984 年年 22 月月 2222 日参考消息:在芝加哥日参考消息:在芝加哥州一州一 2020 岁青年阿伦。因车祸受伤,被宣布死岁青年阿伦。因车祸受伤,被宣布死亡。待取肾脏移植时,他咳嗽了一声。亡。待取肾脏移植时,他咳嗽了一声。

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(1)(1) 认识的提高:生命意义在于机认识的提高:生命意义在于机体 在神经体 液调节下成为 一 个 整 体体 在神经体 液调节下成为 一 个 整 体(( integrityintegrity )。)。机体内部各器官系统相机体内部各器官系统相互协调互协调 ((coordination)coordination) ;;与外界环境适与外界环境适应(应( adaptationadaptation )。)。

仅有呼吸,只能说是肺在扩张和回缩仅有呼吸,只能说是肺在扩张和回缩 仅有心跳,只能说心脏在跳。仅有心跳,只能说心脏在跳。 完整性主要靠脑(中枢神经系统)协调。完整性主要靠脑(中枢神经系统)协调。

Modern viewModern view

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(2)(2)Modern concept of Modern concept of deathdeath

The The electroencephalogram electroencephalogram (EEG) is useful to confirm (EEG) is useful to confirm the cessation of the the cessation of the activity of central activity of central nervous system.nervous system.

Te most important for human life is the integity of the brain function. If the cessation of brain function is irreversible, the heart-beat only does not make sense for the life.

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1)1)Concept of brain deathConcept of brain death

Brain death indicates that all the Brain death indicates that all the activity (function) of whole brain activity (function) of whole brain (including the brain stem) has (including the brain stem) has irreversibly stopped. irreversibly stopped.

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2)2)Criteria of brain death Criteria of brain death from WHOfrom WHO

(A)Irreversible coma and (A)Irreversible coma and cerebral irresponsibility.cerebral irresponsibility.

That means the complete lack of That means the complete lack of cerebral response to any form of cerebral response to any form of external excitations.external excitations.

(B) Cessation of spontaneous Cessation of spontaneous respiration.respiration.

No spontaneous respiration after 15 No spontaneous respiration after 15 minutes of artificial respiration.minutes of artificial respiration.

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(C)Absence of cephalic(brain stem) (C)Absence of cephalic(brain stem) reflexes: reflexes:

(a) (a) The pupillary reflex The pupillary reflex (The (The pupils will shrink, if a strong light pupils will shrink, if a strong light shine.)shine.)

is absent. the both pupils are dilated is absent. the both pupils are dilated and fixed.and fixed.

(b) (b) The corneal reflex The corneal reflex (There will (There will be a blink if touch the corneal with be a blink if touch the corneal with cotton) cotton) is absent.is absent.

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((D) Absence of D) Absence of any electrical any electrical activity of the activity of the brainbrain Linear EEG may Linear EEG may appear even when appear even when stimulating the patientstimulating the patient

(E) Stopping of cerebral blood circulation.

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(3) Difference between brain death and persistent vegetative state A person who is in persistent vegetative state is called plant person. A plant person cannot speak and think by himself or herself.( cerebral function is lost irreversibly) A plant person has:(a) autonomic respiration and heartbeat,(b) normal body temperature( if the room temperature is normal), (c) normal digestion and absorption( if food is given by nasal feeding). So the plant person is not brain death, because the function of brain stem is normal.

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意义意义

器官移植,有法可依,法律保护。器官移植,有法可依,法律保护。 不进行无效抢救(不进行无效抢救( 20022002 年年 1010 月月 2828

日济南时报文章:中国缺少脑死亡法,每日济南时报文章:中国缺少脑死亡法,每年安慰性、仪式性抢救花费数百亿元,年安慰性、仪式性抢救花费数百亿元,

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Euthanasia Euthanasia 安乐死安乐死